Abstract
Objective
The aim of this work was to estimate the magnitude of the differential impacts of
initial treatment status relative to the impact of classic clinicopathologic factors
on the long-term overall survival (OS) of sarcoma patients in a referral cancer center.
Methods
From the institutional database, we identified 2185 patients who presented to the
institutional multidisciplinary team (MDT) prior to (N = 717, 32.8%) or after (N = 1468,
67.2%) initial treatment, with a first diagnosis of sarcoma from January 1999 to December
2018. Descriptive, univariate and multivariate analyses were applied to identify the
factors related to OS. By performing propensity score matching of each completely
MDT-treated patient to a referral patient with similar characteristics, the differential
impacts of the identified risk and prognostic factors on OS in the 2 groups were estimated
by the Kaplan‒Meier survival curves, log-rank test and Cox proportional hazard regression;
the results were compared using calibrated nomograph models and forest plots.
Results
Adjusted for the clinicopathologic factors of patient age, sex, primary site, tumor
grade, tumor size, resection margin and histology, hazard ratio-based modeling analysis
indicated that the initial treatment status was an independent but intermediate prognostic
factor associated with long-term OS. The major impacts of the initial and comprehensive
MDT-based management on significant improvement of the 20-year OS of sarcomas were
reflected in the subgroup of patients with stromal, undifferentiated pleomorphic,
fibromatous, fibroepithelial, or synovial neoplasms and tumors in the breast, gastrointestinal
tract, or soft tissues of limb and trunk.
Conclusions
This retrospective study supports early referral of patients with soft tissue masses
of unknown identity to a specialized MDT before biopsy and initial resection to reduce
the risk of death but highlights an unmet need for a greater understanding of some
of the most difficult sarcoma subtypes and subsites and their management.
Keywords
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Article info
Publication history
Published online: May 03, 2023
Accepted:
May 2,
2023
Received in revised form:
April 7,
2023
Received:
January 30,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
